Percutaneous radio-frequency thermocoagulation with low temperature in the treatment of essential glossopharyngeal neuralgia

Two cases of essential glossopharyngeal neuralgia treated successfully with percutaneous radio-frequency thermocoagulation are reported. In order to avoid cardiovascular complications due to interference with the vagus nerve, a modification of the technique previously used is proposed. The modification used in the cases presented here consists in the use of lower temperature during a shorter time with four progressive steps controlled with electrical stimulation. A small-surface active electrode, exact location in the petrous ganglion, permanent stimulation control, and a smaller thermal lesion are the cardinal features of the technique used in the cases reported.     

Cardiovascular and cerebral complications during glossopharyngeal nerve thermocoagulation

The cardiovascular and cerebral complications observed during percutaneous radiofrequency thermocoagulation of the glossopharyngeal nerve are described. The value of such symptoms in anticipating a lesion of the vagus nerve is discussed.     

Selective percutaneous thermocoagulation of the glossopharyngeal nerve in intractable glossopharyngeal neuralgia

Percutaneous radiofrequency thermocoagulation of glossopharyngeal nerve at the jugular foramen was employed for the treatment of intractable glossopharyngeal neuralgia in three cases, one with essential and two with symptomatic pain from malignant tumor of the oropharyngeal area. Under radiological control, the thermocoagulation electrode was inserted through the lateral cervical route, and the electrode reached the jugular foramen with the tip toward the pars nervosa. The correct position of the electrode was confirmed by radiography and by electrophysiological stimulation test. Once the electrode was properly positioned, lesion was made with temperature of 60 degrees C to 70 degrees C for 1 approximately 2 minutes. Surgical results were satisfactory and no neurological and cardiovascular complications were noted. Percutaneous radiofrequency thermocoagulation of glossopharyngeal nerve is thought to be very useful for the treatment of intractable glossopharyngeal neuralgia.     

Percutaneous thermocoagulation for sphenopalatine ganglion neuralgia

Summary The authors describe percutaneous radiofrequency (rf) thermocoagulation of the sphenopalatine ganglion used to treat seven patients with sphenopalatine ganglion neuralgia.The procedure was effective in relieving pain, without significant side-effects. All the patients have actually been free of pain during a follow-up of 6–28 months. The surgical technique and the rationale for its use are pointed out.     

Chiari type I presenting as left glossopharyngeal neuralgia with cardiac syncope

Glossopharyngeal neuralgia is an uncommon craniofacial pain syndrome that is occasionally associated with cardiac syncope. However, we relate Chiari I syndrome as a cause of this clinical picture for the first time in the literature. The authors analyze the relevant literature and discuss the pathogenesis and treatment of associated syndromes. We describe the case of a 45-year-old female patient who presented with a 3-year history of left glossopharyngeal neuralgia with occasional dysphagia and episodes of syncope when eating or swallowing. The pain was not disseminated to the right side and was fairly well controlled by carbamazepine. The syncopal attacks had a duration of about 10 sec. Neurological examination elicited a faint dysphonia associated with paradoxical dysphagia. The cranial magnetic resonance imaging scan showed a bilateral herniation of the cerebellar tonsils through the foramen magnum, more evidently on the left side. The patient received a suboccipital craniectomy and resection of the posterior arch of C1. The dura mater was opened, and we found both tonsils displaced into the foramen magnum extending caudally toward the C1 level. Both tonsils were compressing the brainstem and especially the low cranial nerves bilaterally. The lower cranial nerves were compressed between the posterior inferior cerebellar artery (PICA) and the herniated cerebellar tonsil on both sides. Both PICAs were dissected by microsurgical technique and all the arachnoid adherences were cut. The left tonsil was resected by means of ultrasonic aspirator. Duraplasty was performed with the occipital pericranium. The paroxysmal pain attacks and the syncopal picture disappeared immediately after the operation. The patient was discharged on the 7th postoperative day. One year later, she was free of symptoms. This case provides clinical evidence of close connections between the glossopharyngeal and vagus nerves, which control visceral sensation; and compression of the IX and X nerves between the herniated tonsil and PICA or vertebral artery may cause an irritative sensory phenomenon, which is the origin of the algic sensation and the cardiac syncope by means of cross talk between the fibers of the same nerve. Electronic Publication     

Percutaneous thermocoagulation of the spinal nerves for analgesia]

The authors present percutaneous technic treatment of some pain syndrom by thermocoagulation of rachidian nerves with radiofrequency generator. This method had been employed on 60 patients in various indications (cervico-occipital neuralgias, low back pain, stage syndrom, painful scar etc...). After anatomic justification one literature analysis precede personal results of this therapeutic method. This one is easy to realise and seems to deserve a good place in the actual possibility of functional neurosurgery.     

Percutaneous thermocoagulation of sacral roots (author's transl)]

Following spinal cord lesions, signs of spasticity may be observed on bladder with decreased capacity and urinary leaks. We have attempted to associate the inocuity of anesthetic blocks and the selective precision of microsurgical rhizotomies by percutaneous thermocoagulation of sacral roots. Bilateral 53 root coagulation, under Rx control, vesical pressure monitoring and stimulation tests, is ususally efficient. Authors report the technic and the results of this simple method about the first nine cases with more than one year of follow up.     

Percutaneous radiofrequency neurolysis guided by computed tomography for the treatment of glossopharyngeal neuralgia

The technique of radiofrequency neurolysis guided by computed tomography for the treatment of glossopharyngeal neuralgia is described. This technique has the advantage of being performed in a neutral head position, affording excellent visualization of the jugular foramen, and also of simulating radiographically the precise trajectory of the electrode. This procedure is of particular value in treating patients with neoplastic disease and those in whom the outlines of the jugular foramen are poorly visualized on fluoroscopy or plain radiography.     

Painless glossopharyngeal "neuralgia" with syncope: a case report and literature review

Glossopharyngeal neuralgia is an uncommon craniofacial pain syndrome. An association with syncope is even less common. We report a case illustrating that the glossopharyngeal neuralgia-syncope syndrome can occur without pain in the sensory distribution of the glossopharyngeal nerve and that it can have similar consequences. We suggest that permanent cardiac pacing alone may be a viable option in the initial management of such cases.     

Surgical management for glossopharyngeal neuralgia associated with cardiac syncope: two case reports

Two patients with glossopharyngeal neuralgia associated with cardiac syncope were treated with temporary cardiac pacemakers for cardiac syncope and then microvascular decompression. The offending arteries were the posterior inferior cerebellar artery in one patient and the anterior inferior cerebellar artery in the other. The offending arteries were attached to the glossopharyngeal nerve and the vagal nerve at the root entry zones. After surgery, the patients were free from neuralgia and cardiac syncope did not occur after the pacemakers were extracted. Implantation of a temporary cardiac pacemaker in the perioperative period ensures safe microvascular decompression.     

Percutaneous endoscopic gastrostomy complicated by buried bumper syndrome

We experienced one case of so-called buried bumper syndrome (BBS) in which the bumper at the tip of the gastrostomy tube was buried in the abdominal wall after a percutaneous endoscopic gastrostomy (PEG). A 52-year-old woman had suffered a cerebral hemorrhage, which led her to become bedridden and eventually caused an aggravation of dysphagia, and as a result, the patient received a PEG. On postoperative day 41, the gastrostomy tube became obstructed, making the infusion of nutrients impossible and producing a leakage of nutrients from around the site of insertion. Endoscopy demonstrated that the bumper within the stomach became buried within the submucosa with only the tip of the bumper being partially observed. Abdominal computed tomography (CT) revealed the bumper to be buried in the abdominal wall. Based on these findings, a diagnosis of buried bumper syndrome was established. The gastrostomy tube was thereafter removed percutaneously and successfully replaced by a new tube at the same site. Although BBS is still relatively uncommon, it may be a complication that deserves increasing attention because PEG is expected to be performed more frequently in the future.     

Transient hyponatriemia complicated by seizures after endoscopic third ventriculostomy.

We present an infant who underwent endoscopic third ventriculostomy due to symptomatic hydrocephalus secondary to aqueductal stenosis. This is the first reported case of inappropriate secretion of antidiuretic hormone complicated by hyponatriemia and seizures following endoscopic surgery. The possibility of such a neuroendoscopic complication should alert neurosurgeons and close observation of serum electrolytes is highly recommended in the acute postoperative period, particularly in infants.     

Percutaneous dilatational tracheostomy complicated by delayed life-threatening haemorrhage.

Percutaneous dilatational tracheostomy has become increasingly popular as an alternative to formal surgical tracheostomy. We report a case of profuse, life-threatening haemorrhage which occurred after percutaneous dilatational tracheostomy.     

Percutaneous Achilles tendon lengthening complicated by inadvertent tenotomy.

Thirteen percent (five of 37) of all Hoke percutaneous triple hemisection Achilles tendon lengthenings performed at a teaching hospital in a 4-year period were complicated by inadvertent Achilles tenotomy. Three of the five patients had bilateral procedures and served as their own controls. After 2 months of postoperative short leg walking cast immobilization, the results in patients with inadvertent Achilles tenotomy were indistinguishable from those in whom tendon continuity was maintained.     

Percutaneous renal biopsy complicated by renal capsular artery pseudoaneurysm

We report a case of renal capsular artery pseudoaneurysm caused by percutaneous renal biopsy. The injury was diagnosed and treated with arteriography and transarterial embolization. Because the arterial injury was extraparenchymal, the clinical manifestations of blood loss were flank pain and decreasing hematocrit without hematuria. Injury to renal capsular arteries during percutaneous renal biopsy is a rare possibility because of their small size.     

Trigeminal neuralgia. Percutaneous thermocoagulation of the trigeminal nerve (author's transl)

200 cases of percutaneous thermocoagulation of the trigeminal nerve were studied in order to determine if the position of the thermolesion in the various parts of the trigeminal system modified the quality of the results and the frequency of post-operative complications. An anatomo-radiological study allowed the precise localisation in the sagittal plane of the position of the different parts of the trigeminal ganglion with respect to the neighbouring bony features. The quality of the results and the frequency of complications were studied according to the level of the thermolesion (ganglion, triangular plexus, posterior sensory root). This study permitted the observation that the more posterior the thermolesion, the less frequent the complication, and this confirmed results obtained in earlier procedures, c.g. gasserian or retro-gasserian neurotomy. Post-operative hypoaesthesia extending beyond the painful area, was the major side-effect of the radicular position of the thermolesion. There follows a discussion of the criteria, which permit the recognition of the point of the electrode at the level of the posterior root: the flow of CSF, vasodilatation, and radiological localisations. Of these three criteria, only radiological demonstration (point of the needle posterior to the clivus and above the petrous temporal bone) seemed reliable.     

B超引导下经皮肾镜气压弹道联合超声碎石术治疗复杂性肾结石

目的 探讨B超引导下经皮肾镜气压弹道联合超声碎石术治疗复杂性肾结石的临床疗效.方法 复杂性肾结石患者382例.男218例,女164例,平均年龄41(4～74)岁.均行B超、KUB加IVU检查,行CT检查285例,逆行肾盂造影检查9例.结石直径1.0～7.5 cm.结石单发65例、多发317例、鹿角形结石95例.左侧169例、右侧140例、双侧73例.其中患肾有手术史52例,合并泌尿系感染127例,肾功能不全31例,其中氮质血症期18例、尿毒症前期13例.均采用B超引导下经皮肾镜气压弹道超声碎石清石系统治疗.结果 382例405侧均一期成功建立24 F经皮肾通道(1例为16 F,应用8.9 F输尿管镜),一期碎石397侧,二期碎石8侧,一期碎石中行2通道碎石14侧.双侧同时碎石23例,2例1侧行2通道碎石,3例第2侧行二期碎石.平均手术时间93min.术中出血量平均70 ml,输血9例.术后平均住院时间5.5 d.一期结石清除率为89.9%(364/405),总结石清除率为91.8%(372/405).术中无气胸、腹腔脏器损伤等严重并发症发生.术后3～5d复查B超或KUB,41例有结石残留,结石最大径0.3～2.5 cm.8例8侧于术后5～7 d行二期碎石,14例残余结石最大径0.5～1.5 cm者辅以体外冲击波碎石治疗,≤4 mm结石19例予药物排石等保守治疗.术后随访1～3个月拔除双J管.术前肾功能不全31例患者,术后1个月复查血肌酐值恢复正常25例.146例获随访3～24个月,结石无复发.结论 B超引导下经皮肾镜气压弹道联合超声碎石效率高、并发症少,是治疗复杂性肾结石的重要方法.